We investigated the usefulness of a wide-angle-viewing videoendoscope for the examination of upper gastrointestinal tract. The instruments used for this study is Olympus XGIF-QW230 with a modified objective lens. It had the same specifications except the field of view, which is 140 degrees with the GIF-Q230 and 170 degrees with the XGIF-QW230. In vitro and in vivo examinations showed that it was possible to observe a wider area with the XGIF-QW230 than with GIF-Q230. Further the described distortion of the periphery did not disturb in vivo observation. It makes also observation of the superior duodenal angle and distal part of anastomosis easier. Therefore, we conclude that a videoendoscope XGIF-QW230 is useful for routine examination for upper gastrointestinal tract.

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Complete fibrosis of the mucosal proper layer and submucosal layer of esophageal wall is main mechanism to threat the esophageal varices by endoscopic injection sclerotherapy (EIS) using paravascular injection of a sclerosing agent. We thought direct thrombosis of small vessels with a diameter of 2mm or less, which might develop large variceal vessels in the future, was desirable as complete and also preventive measure. In this point of view, laser photocoagulation had advantage over EIS. However, the conventional Nd : YAG laser irradiation could not perform the complete thrombosis without vessel perforation. In this study, we developed a novel method of enhancing diode laser absorption by intravenous administration of indocyanine green (ICG) , which strongly absorbed 805nm diode laser light. In all cases, slow injection of 0.5mg/kg ICG in 30 sec. was followed by drip injection of same dose in 15 min. Repeat irradiation was performed with 1 sec. exposure of 25W output during drip injection. Histological specimen obtained just after irradiation reveals extensive fusion necrosis of fibrous tissue in mucosa and submucosa without obvious muscle damage. The obvious thrombosis in both venous and artery was not present, however, 7 days after these necrotic area was completely replaced by fibrosis. We applied this method to 4 patients who carried esophageal varices after large varicose veins were treated by EIS or Endoscopic Variceal Ligation (EVL) . Laser irradiation disappeared all small vessels, which previous procedures failed to treat, and endoscopy has showed no recurrent vessels 5 months after exposure. No complication such as pain, persistent bleeding, perforation and deteriorated liver function developed during the treatment and the observation period. Our laser method in combination with EIS or EVL might be a safe and effective therapeutic method by treating small vessels. The increasing dose of ICG injection still remains to be examined for more effective treatment for esophageal varices.

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It is important to detect portal systemic system for selecting the treatment of solitary gastric varix. Arterioportography (AP) et al has been mainly performed to detect portal systemic system. In recent year, three-dimensional computed tomography (3D-CT) et al as less invasive methods have been also performed. The purpose of this study is to compare between the usefulness of AP and 3D-CT to detect gastrorenal shunt as the portosystemic system of solitary gastric varix. Seven patients in whom gastric varix were endoscopically demonstrated were examined. Out of seven, 3 had gastric varix without esophageal varix and four did gastric varix with one. As a result, in all 3 gastric varix without esophageal varix, gastric varix and gastrorenal shunt were detected by both AP and 3D-CT. However, in all 3 cases, inferior phrenic vein connected with gastrorenal shunt was detected by only 3D-CT. In all cases of 4 gastric varix with esophageal varix, gastric varix was detected by AP. However, In 2 cases out of four, gastrorenal shunt was detected by AP. In all 4 cases, gastric varix and gastrorenal shunt were detected by 3D-CT. In all 4 cases, inferior phrenic vein connected with gastrorenal shunt was detected by only 3D-CT. In all 7 cases, the orifice of gastrorenal shunt to renal vein was in detail detected by 3D-CT. Therefore, it is thought that 3D-CT is more useful to detect inferior phrenic vein connected with gastrorenal shunt and the orifice of gastrorenal shunt to renal vein than AP.

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We have been evaluating a colic motility with extrasomatic ultrasonography, it is called water sealed method (WSM) . It was able to evaluate colic motility from the cecum to the decending colon. In the right colon, it was strong relation between peristalsis contractions and migration of the intestinal contents. But in the colon from the transverse colon to the descending colon, the relation between peristalsis contractions and migration of the intestinal contents was not clear. Therefore the right colon would have'active transit function'. This time we would like to evaluate with WSM and colonoscope how right colon has peristalsis contractions. In the examination with WSM the active peristalsis contraction of the right colon started at the cecum toward hepatic flexure. Tension of the crescentic folds and hausta, and relaxation of the cecum were important factors for the peristalsis contractions. On the other hand, in the examination with colonoscope segments in the right colon divided by the crescentic folds were compressed serially from the cecum toward hepatic flexure. In other words the right colon has active peristalsis contractions like the cornice, and the contractions like the small intestine were not observed at all. Three important factors were as follows.
1) the crescentic folds make septums in the right colon sufficiently.
2) segment internal pressure is kept by tension of the intestinal wall.
3) the segments were compressed serially from cecum toward hepatic flexure.

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A 56-year-old man received esophagectomy against advanced esophageal carcinoma in July, 1997. Gastric roll was utilized for substitution. Postoperative irradiation, a total dose of 48Gy, was performed four month after the surgery to uppermediastinum and bilateral upperclavicular area. In April 1998, he was admitted to our hospital due to bloody stool. Endoscopy revealed severe gastric erosion which was supposed to be resulted by radiation. As the coagulation with high frequent wave was ineffective for hemostatic procedure, we adopted Argon Plasma Coagulation (APC) in September 1998 and succeeded in hemostasis of the widely-spread circular erosion in gastric roll. The bleeding never recurred until he died of a disseminated carcinoma. As APC is considered to coagulate only the surface of mucosa, cicatricial stenosis could hardly happen even if coagulated to circular lesion. This feature is to be evaluated as one of the most useful device for gastrointestinal hemarrhage.

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A 71-year-old male has been followed up by his home doctor due to thrombocytopenia since 1992. In January 1998, he was referred to our hospital under diagnosis of multiple gastric ulcers. Endoscopy revealed multiple, band-like hemorrhagic ulcers along lesser curvature through anterior wall in lower body. Blood test showed both thrombocytopenia and eosinophilia. We succeeded in endoscopic hemostasis by fulguration, but the ulcer was resistant to our treatment and flared easily even under condition of uninterrupted PPI administration. This patient was diagnosed as hypereosinophilic syndrome (HES) from the clinical criteria, and either eosinophilia or gastric ulcer responded fruitfully to steroid treatment. Eosinophil infiltration was observed in the endoscopic biopsy specimen from ulcerative lesion, thus we concluded these ulcers resulted from HES.

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A 61-year-old man who was pointed out icterus in a previously healthy adult was admitted to our hospital. Findings of blood chemistry showed icterus and liver dysfunction, whereas, hepatitis virus antibodies and HIV antibody were all negative. The patient had heart burn on admission and fecal occult blood was positive. Upper G-I endoscopic finding revealed multiple active ulcers on the duodenum. Culture of Helicobacter pylori from the gastric biopsy specimens and ¹³C-urea breath test were negative. The patient was treated with H₂-receptor antagonist for two months at first, but the duodenal ulcer were unchanged. His intractable duodenal ulcers was diagnosed to be induced by cytomegalovirus (CMV) infection because of high titer of CMV-IgM antibody and detection of CMV-DNA from the liver biopsy specimens using PCR. The patient was tried to treat with anti-CMV drug, Ganciclovir 500mg, for two weeks. His heart burn and epigastralgia were reduced and duodenal ulcers were cured to scar immediately.

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We reported a 58-year-old man with carcinoma of the papilla of Vater, of which endoscopic findings had changed remarkably during a short term. In the first endoscopic findings, the papilla of Vater had shown mild swelling. However, 19 days later, it showed prominent swelling with an irregular surface. Macroscopic findings of resected specimen showed carcinoma of the papilla which invaded to pancreatic parenchyma through the proper muscle of the duodenum. Histological findings showed the carcinoma which was characterized by tubular projections with scant fibrous cores and was suggestive of originating from common channel epithelia.
It was reported that the carcinoma of the papilla of Vater, originating from common channel epithelia, was more invasive into the surrounding interstitium than that from intestinal epithelia. This case was supposed to be originated from common channel epithelia and invasive strongly. Therefore it is thought that a remarkable change in the endoscopic findings was seen during a short term.

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A 41-year-old male was admitted to our hospital, complained of abdominal pain and hematochezia. When he was 29-year-old he was diagnosed as periarteritis nodosa (PN) because of fever, arthritis, skin nodules, ulcers of tongue, and skin biopsy, He have been treated with prednisolone since then. Two months after that diagnosis, appendectomy was performed, and terminal ileitis was pointed at the same time. In January 1998, colonoscopy was performed and it revealed an ulcer occupied half of circumference in the terminal ileum. Biopsy specimens taken around the ulcer showed non-specific ileitis, so we diagnosed the ulcer caused by PN according to clinical information. The ulcer was improved with steroid pulse therapy and cyclophosphamide, but ulcer recurred during tapering prednisolone. Ulcer was improved again, responding to the increasing of corticosteroid. Endoscopic observation of ileal ulcer complicated by periarteritis nodosa is very rare.

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A 22-year-old homosexual male was admitted becuse of positive HIV. Colonoscopy was performed becouse of persistent diarrhea On the 39 days after. A punched-out ulcer was detected on ileocecal valve. Biopsy specimens showed inclusion bodies, furthermore it was positive by immunological stain for CMV antigen by immunological stain. CMV colitis was diagnosed and he was started Ganciclovir therapy. On the 84 days Follow-up colonoscopic examination showed ulcer scar on the ileocecal valve after 45 days treatment.
It has been reported for CMV infection of gastrointestinal tract is commonly seen with AIDS. It is important to perform endoscopic examination for prompt diagnosis of CMV infection.

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A 54-year-old man was admitted for endoscopic mucosal resection. The lesion was located on pylorus ring. Normal saline was injected from duodenum. We did this method by retroflexed endoscopy in duodenal bulb. Due to this method, the lesion was observed easily from stomach and we could perform endoscopic mucosal resection. There is no stenosis of the pylorus ring. This method is available for the lesion on the pylorus ring.

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We reported two patients who had sigmoid colon cancer that was performed endoscopic piecemeal mucosal resection (EPMR) under the retroverted observation. The first case was a 73-year-old man, who had sigmoid colon cancer (villous tumor, 40mm in diameter) . Under retroverted observation, Submucosal injection and partial resection was performed and in ordinary observation, complete resection was performed. Histopathological study revealed well differentiated tubular adenocarcinoma (mucosal cancer) . The second case was 79-year-old man, who had sigmoid colon cancer (nodule-aggregating lesion, 40mm in diameter) . Under retroverted observation, submucosal injection was performed and under ordinary observation, additional injection was performed. The lesion was well lifted after submucosal injection and complete resection was performed. Histopathological study revealed well differentiated tubular adenocarcinoma (mocosal cancer) . The submucosal injection under retroverted colonoscopic observation was useful for the resection of lesions over 30mm in diameter.

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Objects & Methods : We examined 17 patients suffering from peptic ulcers. We confirmed H. p. infection by culturing, microscopy and urease testing. 1) We graduated the degree of the inflammatory change and atrophic change of the gastric mucosa from the endoscopic findings. 2) We examined gastric mucosal flakes under microscopy, scoring the atrophic changes and inflammatory change, from biopsies at Sano's 4 points.
Results : 1) The degree of the inflammatory change of the gastric mucosa decreased after the treatment of H. p. infection from the endoscopic findings and the pathological view points. 2) The degree of the atrophic change of the gastric mucosa didn't change after the treatment from the endoscopic findings. 3) But the degree decreased from the pathological view points at the anal side of the stomach.
Discussion and Conclusion : We could evaluate the gastric mucosal inflammatory change from the endoscopic findings and the pathological view points. But we could evaluate the gastric mucosal atrophic change only from the pathological view points.

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It is thought that it is not easy to stop bleeding from severe portal hypertensive gastropathy (PHG) due to liver cirrhosis by conservative treatment et al. It has been already reported that PHG is pathologically the dilated vessels in gastric mucosa. Therefore, it is thought that partial splenic embolization (PSE) is one of useful treatment for bleeding from PHG because the pressure of the portal vein was decreased after PSE. This study is to determine the usefulness of PSE to stop the bleeding from PHG. From November 1997 to May 1999, five patients have hematoemesis and/or melena due to bleeding from severe PHG by panendoscope. Primary diseases in all patients were liver cirrhosis with Child C. It was to embolize 30%-50% of spleen by PSE. Four patients had severe hypersplenism and residual one did mild one by angiography et al. As a result, in four cases with severe hypersplenism, the bleeding was just stopped after PSE. In residual one with mild splenomegaly, bleeding was just stopped after PSE. However, two days after PSE, the patient was died due to hepatic coma. Therefore, it is thought that PSE is useful to stop the bleeding from PHG in the cases with severe splenomegaly.

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We examined 15 cases of primary duodenal cancer except ampullary cancer. Four cases of cancer in the bulb included 3 early cancers, and 11 cases of cancer in the 2nd portion included 2 early cancers. Histopathological examination showed 3 poorly, 1 moderately, and 11 well differentiated adenocarcinomas. Three cases of early elevated cancer in the bulb were performed endoscopic mucosal resection (EMR) , but 1 case was added surgical operation because of invasion into the submucosal layer. All patients of early cancer, except one patient died of another disease, are still alive. But 7 patients of advanced cancer died within two years after surgical operation. The early cancer of poorly differentiated adenocarcinoma formed IIa type with normal mucosa on the outside area.

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A 52-year-old man was admitted to our hospital because of exacerbation of the symptoms, such as limp and tremor. HTLV-1 associated myelopathy (HAM) , which it was six years since he was diagnosed. Then he started to take Predonisolone (PSL) 30-60 mg/day. After treatment by PSL, symptoms of HAM were gradually improving. But from 50th hospital day, epigastralgia, nausea and vomitting were appeared, following by bloody stool. An X-ray film of the abdomen showed the small bowel gas with the fluid level. Endoscopic examination revealed diffuse redness, erosion and swelling in the duodenal second portion and bulb, and circumferential redness and swelling of esophageal mucosa from pharyngoesophageal junction to esophagogastric mucosal junction (EG junction) , and with two or three linar erosion near EG junction. The biopsy specimen from the duodenum showed larvae of Strongyloides stercoralis, but not the esophagus. This case was thought that severe Strongyloidiasis with esophageal lesion was developed while giving steroid therapy for HAM.

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We observed the procedure of occurrence and healing of submucosal dissection of the esophagus with a giant gastric ulcer on the cardia with endoscopic and Roentogenogram examination. We reported 4cases adding other 3 cases which were treated in our department with some discussion based on literature.
A 64-year-old female visited our hospital complaining vomiting three times after meal, oppressive feeling at chest, and dysphagia, on Dec. 11.
Endoscopic examination at admission revealed hemorrhage and submucosal dissection of the esophagus from E-G junction up to middle portion. Acute gastric ulcer located on the cardia.
Submucosal dissection was seemed beginning to edge of the gastric ulcer.
We diagnosed submucosal dissection of the esophagus and started conservative treatment. Endoscopic examination at the 7th day of the treatment showed that submucosal dissection was in healing and that the gastric ulcer was into healing stage.
Submucosal dissection of the esophagus can be categorized into idiopathic and external case. In idiopathic cases, the increase of the pressure in esophagus by vomiting is considered as one of its causes.
The present case gave us the question to examine if submucosal dissection of the esophagus followed the gastric ulcer or if they occurred at the same time.

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This paper describes a case of granular cell tumor (GCT) of the esophagus, of which was endoscopically diagnosed and resected.
A 43-year-old with multiple GCTs In lower esophagus had been followed up for 7 years and was admitted to our hospital with earnest patient wish for tumor removal. Endoscopy revealed five GCTs with diameter of 7, 10, 20, 42, and 12mm respectively. Endoscopic biopsy showed S-100 positive tumor cell with characteristic eosinophilic granules, of which nuclei were small and moderately hyperchromatic. EUS represented that the tumors had no invasion to proper muscle layer, thus we adopted endoscopic treatment for GCT removal.
In literature views esophageal GCT is a relatively rare disease and so far a total of 170 patient were reported in Japan. The size of the tumor is mostly less than 30mm and only 2% of the tumors behave as malignant tumor. Our case had seven years follow-up period and seemed to have had the biggest tumor among the cases treated endoscopically.
Further observation would be required to avoid unfavorable regrowth and/or tumor relapse.

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Gastric carcinoma in the preceding stage of typical type4 gastric carcinoma was rare to encounter. In this case the main lesion was IIc-like advanced gastric carcinoma on the greater curvature of the antrum. Subtotal distal gastrectomy and D2 lymphnode dissection was done. Macroscopically the distance between the oral margin of the tumor and the surgical margin of the stomach was about 6.5cm and the surgical margin was thought to be free of carcinoma cells. But histologically carcinoma cells infiltrated scattered in the submucosal layer to the oral surgical margin. Lymphatic invasion of the carcinoma cells was not seen in the submucosal layer and fibrous change was very little. The exact detection of the oral spread of the carcinoma preoperatively had been impossible. This case was belonged type4 gastric carcinoma because the submucosal spread was very wide compared with the mucosal spread. And this case was thought to be in the preceding stage of typical type4 gastric carcinoma.

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We have reported that PhotoDynamicTherapy (PDT) on inoperable gastric cancer and unable case for endoscopic mucosal resection (EMR) . On this report, we handle such case for using PDT and Nd-YAG Laser.
A 69-year-old woman, had Type IIc gastric cancer with poorly differentiated adenocarcinoma cells. She had also trouble with severe respiratory dysfunction that impossible to recieved routine upper gastric endoscopy examination. Endoscopic ultrasonography examination implied invasion of submucosal layer. We decided to make gastric fistula, so that she could endure long term endoscopic procedure.
We made fistula in middle body of anterior wall by using endoscopy. Fifty hours after intravenous injection of PHE (Porfimer sodium) , we performed Excimer Dye Laser (EDL-1) . One week after PDT, histological biopsy specimen showed residual cancer cells. We performed Nd-YAG Laser as additional therapy on that lesion. After 4 months of laser therapy, histological biopsy specimen was not revealed carcinoma cells. It was considered that inoperable case, or unsuitable case for EMR, endoscopic laser therapy will show the efficacy for local cure.

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We treated a case of giant gastric polyp using a new resection technique-one port intragastric endoscopic surgery. A 84-year-old male was admitted to our department suffering from anemia. Gastric fiberscopy and an upper GI series revealed a giant adenomatous polyp in the distal region of the stomach. The lesion was 40 mm in diameter, with a stalk of 20 mm. We determined that it would be difficult to remove by conservative endoscopic procedures because of the thick stalk. The surgery was performed under general anesthesia, in the supine position. A panendoscope with 2 channels was inserted through the mouth. First, the anterior gastric wall was fixed to the abdominal wall using Funada fixing equipment. A 12-mm trocar was then inserted into the stomach to the left upper quadrant of the abdomen, after observation. The tumor was pulled by snare wire through the endoscope and resected with a 45 mm linear stapler that was inserted through the trocar. No bleeding or leakage were observed. The puncture wound in the stomach was closed with endoscopic clips. The abdominal wound was closed by hand, and the procedure was completed without difficulty. The postoperative course was uneventful, and the patient was discharged from hospital on the 7th postoperative day, after gastric fiberscopy observation.

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A 63-year-old female with rheumatoid arthritis complaining of anemia was admitted to our hospital. Peripheral blood examination on admission showed pancytopenia and macrocytic normochromic anemia. Blood chemistry examination demonstrated that high level of gastrin, autoanitibody to parietal cells and intrinsic factor, and low level of Vitamin B₁₂. Pernicious anemia was observed on the bone marrow aspiration material. Endoscopic examination showed only an atrophic gastritis, however metachromasia was not demonstrated by means of Congo-red test. And 24 hour pH monitoring of gastric secretion also revealed continuous prominent low level of its acidity. These findings indicated that this case was a rare type A gastritis with Rheumatoid Arthritis.

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We experienced a case of perforation of the remnant stomach due to naso-gastric tube was treated by PEG.
A 73-year-old male, being operated for gastric cancer, had high fever on the 7th post operative day. The contaminated fluid was drainaged from the abdominal cavity. Free perforation of anterior wall of the remnant stomach was observed by Gastrofiberscopy on the 34th post operative day. We preferred to treat it conservatively but condition of the patient was deteriorated gradually.
A balloon catheter was inserted through cutaneous and perforated lesion of gastric wall using the method of PEG on the 36th post operative day. The patient began to recover remarkably. The balloon catheter was removed on 20th day after PEG and the fistule was completely closed in 19 days. The patient was discharged at 84th post operative day.
We reported our experience of the perforation of the remnant stomach treated by PEG successfully.

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A 66-year-old woman was admitted to our hospital because of dyspnea. She was undergone the tumorectomy in her left mandibular malignant melanoma five years ago. Her laboratory data indicated anemia and inflammation. Her dyspnea was considered due to bronchitis and was improved by administration of antibiotics. The endoscopic examination showed a blackish elevated lesion with central depression in the anterior wall of bulbus and pathological findings indicated the invasion of malignant melanoma cells. Multiple metastasis in bilateral adrenal grands, liver, small intestine, and brain were finally discovered, and the combination therapy using IFN-β and DAV (DAV-Feron) was performed. The endoscopic examination after three regimens showed decrease of duodenal lesion and clearance of pigmentation. And CT-scan revealed disappearance of liver metastasis and reduction of bilateral adrenal metastasis. We report have a case of multiple melanoma metastasis successfully treated with chemotherapy.

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This paper represents a 40-year-old UC case, of which lesion was un-favorably reactivated after proctopexy. She was diagnosed as UC (total colitis type) in 1984 and had been medicated with by prednisolone (PSL) and salazosalfapyridine (SASP) . Ever since medication was quitted in 1988, she had been in remission stage successfully. There had been neither clinical symptoms nor colonoscopical finding which would suggest relapsing. In July 1998, she was performed proctopexy for proctoptosis under spinal anesthesia. Although only negligible erosions were seem in rectal mucosa during the surgery, severe low abdominal pain and bloody diarrhea (4-5 times/day) happened to appear two days after the surgery (Day2) . Diclofenac sodium suppository had been used as antipyresis and analgesic for four days (Day 6-9) . Sigmoidscopy was performed at 10 days after proctopexy. It was observed that diffuse mucosal edema and erosions in the rectum and sigmoid colon, diagnosed as severe UC. Furthermore, longitudinal mucosal redness and round-like ulcers in the sigmoid colon were also observed. Immediately PSL (50mg/day) and antibiotics were administered by bolus drip infusion for one hour under fasting and hyperalimentation control and the symptoms had disappeared mostly within a week. This onset might result from surgical procedures and/or NSAID suppository.

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[in Japanese]

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A 25-year-old twin male patients have had polyposis coli over 100 polyps in the total colon. His elder brother died with multiple metastases from descending colon cancer. Therefore, he received a laparoscopic assisted total colectomy with ileoanostomy. Histopathological examination showed that all polyps except one were tubular adenomas. However, one of them showed intramucosal cancer with adenoma. They have no family history of polyposis coli or colorectal cancer. Reports about the polyposis coli in twins are very rare in Japan.

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A 44-year-old woman was admitted to our hospital because of bright bleeding per anus. After colonoscopy, it was suggested that the cause of bleeding was due to autoamputation of semipedunculated polyp in the transverse colon. Initially, endoscopic clipping was performed to prevent re-bleeding. Laparoscopic partial resection was performed because the pathological diagnosis of the biopsy specimen taken from the lesion suggested highly carcinoma. The residual lesion was well differentiated adenocarcinoma limited in the mucosal layer.

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A 61-year-old man had three pedunculated sigmoid colon polyps resected endoscopically. Since all of the polyps were markedly reddish and moderately large, about 2 cm in diameter, detachable hemostatic snares were used to prevent postpolypectomy bleeding. His condition was stable until 6 days after the polypectomy, when a massive bloody stool defecated suddenly. An emergency colonoscopic examination showed hemorrhagic ulcers at the sites ligated by the detachable hemostatic snares. The hemorrhage ceased spontaneously without special treatment. This is thought to be the first case report showing the possibility of hemorrhaging from the ulcer at the site of ligation taking place after the natural detachment of the hemostatic snare.

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A 45-year-old man with pancreatic tumor, which incidentally found by abdominal ultrasonography on health checkup, was admitted to our hospital. The tumor measuring about 1.0cm in diameter was found in tail of pancreas by computed tomography, and its ring-enhancement was observed in contrasted CT. Endoscopic ultrasound showed an iso-low echoic mass in the taii of pancreas. Surgical operation was performed subsequently. Pathological examination revealed that the inside of cyst wall was lined with squamous epithelium, and lymphoid tissue, siderophore, and cicatrices were seen in surrounding area. Thus it was diagnosed as a lympoepithelial cyst of the pancreas. Lymphoepitherial cyst of the pancreas is rare lesion, which has reported about 30 cases to date since it was first recognized in 1985. We reported a case of lymphoepitherial cyst of the pancreas and discussed it and 29 cases in the literature.

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A 21-year-old female patient was admitted to Kyorin University Hospital with general fatigue. She had a slight elevation of serum transaminase levels and total gamma globulins, and was positive of antinuclear antibodies. Her clinical characteristics had 16 points of AIH scoring system reported by International autoimmune hepatitis group. Laparoscopic findings showed a gentle undulation and multiple reddish markings at the liver surface. There were interface hepatitis with portal expansion, fibrosis, and lymphocytic infiltration by histological examination. She was treated with corticosteroid (30mg/day prednisolone was given initially, then tapered down the dosage) , and serum transaminase levels were normalized. This case had mild liver dysfunction, but laparoscopic findings were severe. It was concluded that laparoscopic examination was useful to have correct data of diagnosis in this case.

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